Assessing Digital Health Maturity in Nigeria: Evidence from a Sub-national Assessment across ten (10) states and strategic imperatives for the health sector

Digital health technologies are pivotal for strengthening health systems and accelerating progress toward Universal Health Coverage (UHC). In Nigeria, while digital health interventions have been widely introduced, disparities in maturity and effectiveness are evident across different states. This study comprehensively assesses digital health maturity across ten Nigerian states, leveraging the Global Digital Health Index (GDHI) framework and the UN Foundation/ICT4SOML maturity model. Employing a mixed-methods approach that includes key informant interviews, document reviews, and quantitative scoring, the analysis evaluates seven core domains: leadership and governance, strategy and investment, legislation and compliance, standards and interoperability, infrastructure, workforce, and services and applications. The analysis also situates surveyed states along a maturity spectrum from experimentation to mainstreaming. Findings reveal substantial variations in digital health readiness among the ten states. Lagos emerged as the most advanced, demonstrating robust governance structures, interoperability initiatives, and strategic investments in ICT infrastructure. In contrast, states like Gombe, Niger, Bauchi, Sokoto, Borno, Nasarawa and Yobe were the least matured, hindered by weak workforce capacity, poor infrastructure, and a lack of standardized interoperability. The assessment further identifies heavy reliance on donor-driven projects, limited state ownership, and fragmented governance as key barriers to sustainable digital health implementation. To address these gaps, the study recommends establishing a National Digital Health Observatory for benchmarking and peer learning, alongside targeted state-level capacity building and infrastructure investments. The findings highlight the urgent need for stronger political commitment, structured governance, and the domestication of national digital health policies at the sub-national level. By mapping states on a digital health maturity spectrum, this study offers a clear framework for targeted interventions, optimized resource allocation, and accelerated progress toward a resilient, interoperable digital health ecosystem across Nigerias states.